Benefit News

Anthem and Memorialcare Hospitals Terminate Contract

August 15, 2017

Anthem Blue Cross and MemorialCare Health System ("MemorialCare") have been engaged in negotiations and have been unable to reach reasonable contractual language and reimbursement rates that are beneficial to both organizations. Unfortunately, Anthem and MemorialCare were unable to reach agreement and the hospital contract terminated effective 12:00AM, August 15, 2017.

MemorialCare includes the following hospitals:

Long Beach Memorial Medical Center (050485)

Community Hospital of Long Beach (050727)

Miller Children's and Women's Hospital of Long Beach (053309)

Orange Coast Memorial Medical Center (050678)

Saddleback Memorial Medical Center (050603)

Members do not have to change doctors, the termination of contract is only for the hospitals listed above

This termination affects members who are enrolled in Commercial PPO, EPO, HMO, and POS benefit plans and receive care at MemorialCare hospitals. Members who have Medicare Part C are affected, however, those with a Medicare supplemental policy for Part A and Part B (Medigap), are not affected by this contract termination.

All non-emergency hospital services must be approved by the HMO member's participating medical group/IPA. If approved, Anthem Blue Cross will cover the claim at the member's in-network benefit levels. If not approved by the member's participating medical group/IPA, the claim will be denied, as stated in the members Evidence of Coverage (EOC).

Many doctors have admitting privileges at more than one hospital. Just because a member's doctor may have admitting privileges at MemorialCare does not necessarily mean that a doctor cannot treat his or her patients at another participating hospital.

Anthem Blue Cross does not share details of its confidential contract negotiations with the public. Negotiations often do work themselves out after the contract termination date, but that is not always the case. Anthem is working collaboratively with MemorialCare as well as the PPO physicians and medical groups that maintain admitting privileges to the hospital, to ensure a smooth transition for members.

Burnham Benefits does not engage in the practice of law and this publication should not be construed as the providing of legal advice or a legal opinion of any kind. The consulting advice we provide is intended solely to assist in assessing its compliance with the Patient Protection and Affordable Care Act and other applicable federal and state law requirements, and is based on Burnham Benefit’s interpretation of federal guidance in effect as of the date of this publication. To the best of our knowledge, the information provided herein, and assumptions relied on, are reasonable and accurate as of the date of this publication. Furthermore, to ensure compliance with IRS Circular 230, any tax advice contained in this publication is not intended to be used, and cannot be used, for purposes of (i) avoiding penalties imposed under the United States Internal Revenue Code or (ii) promoting, marketing or recommending to another person any tax-related matter.

Burnham is a modern employee benefits and insurance services company. We apply a unique blend of expert knowledge, unmatched personal service and proactive planning to create proven strategic solutions and promote a culture of wellness for our clients.

Burnham is a certified B Corp, a designation reserved for companies who reflect not just the desire to be the best in the world, but the best for the world.